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Abstract
Primary hyperparathyroidism is usually caused by a parathyroid adenoma, occasionally by primary parathyroid hyperplasia and rarely by parathyroid carcinoma. Coincidental occurrence of thyroid carcinoma in parathyroid adenoma is not uncommon, but synchronous parathyroid and thyroid carcinoma is extremely rare. Here, we describe a case of synchronous parathyroid carcinoma and papillary thyroid carcinoma.
A 68-year-old female with no history of neck irradiation presented with hyperparathyroidism by parathyroid mass that was observed during the treatment of bronchiolitis obliterans organizing pneumonia. During the preoperative evaluation thyroid nodules were also observed. Therefore, she underwent surgery at Konyang University Hospital and was diagnosed with coexisting parathyroid and papillary thyroid carcinoma.
Figures and Tables
Fig. 1
Radiologic findings of hyperparathyroidism. A. Skull X-ray shows heterogeneous salt and pepper appearance of skull. B. Digit X-ray shows resorption of the phalangeal tufts (subperiosteal resorption). C. The DEXA of the spine shows the T-score for L1 is -3.7. The DEXA of the hip shows femoral neck T-score of -2.6 and total score of -2.6. The higher values for L2, L3 and L4 are related to the degenerative change. These findings would be consistent with that of severe osteoporosis.
Fig. 2
A, B. A preoperative neck ultrasonography. Ultrasonographic findings of the neck shows about 2.43 cm sized mass lesion is seen in right lower perithyroid area (A), about 1 cm sized cystic lesion is seen in left. thyroid lower pole (B). C, D. A preoperative axial neck CT scan. C. The calcified right parathyroid mass (thick arrow, 2.4 × 1.5 cm) has heterogeneous density and irregular margin from the thyroid gland. And left thyroid lobe nodule (thin arrow, 1.3 × 1.2 cm) was diagnosed as follicular adenoma. D. The right thyroid lobe nodule (thick arrow, 1.3 × 1.2 cm) which was finally revealed as a papillary carcinoma with ossification are seen. E. MIBI scan. Focal abnormal uptake persistently in right lower thyroid area in early and 2-hour delayed imaging. Cell survival curves measured by cell counting kit-8 after 48 hours of treatment with re-differentiation agents in FTC-133 cells. U0126, selective inhibitor of MEK1/2; LY294002, selective inhibitor of PI3K; TSA, trichostatin A.
Fig. 3
A, B. Microscopic examination of the right lobe of the thyroid gland after decalcification shows a nodular tumor with ossification in a low-power view (A, ×12.5) and many nuclear pseudoinclusions in a high-power view (B, ×400). C, D. A scan view of the parathyroid gland shows broad intratumoral fibrous bands separating expansile tumor nodules (C). Microscopic examination shows vascular invasion in a medium-power view (C, ×100), and severe nuclear pleomorphism in a high-power view (D, ×200).
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